Hepatomegaly: Difference between revisions
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{{Short description|Enlargement of the liver}} |
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{{Infobox medical condition (new) |
{{Infobox medical condition (new) |
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| name |
| name = Hepatomegaly |
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| image |
| image = Se000.jpg |
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| caption |
| caption = Computerized tomography of affected person with hepatomegaly |
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| symptoms |
| symptoms = Weight loss, lethargy<ref name=pat/> |
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| complications |
| complications = |
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⚫ | '''Hepatomegaly''' is enlargement of the [[liver]].<ref name="nih">{{Cite web| url = https://www.nlm.nih.gov/medlineplus/ency/article/003275.htm| title = Hepatomegaly: MedlinePlus Medical Encyclopedia| website = www.nlm.nih.gov| access-date = 2016-02-27| archive-date = 2016-07-05| archive-url = https://web.archive.org/web/20160705044650/https://www.nlm.nih.gov/medlineplus/ency/article/003275.htm| url-status = live}}</ref> It is a non-specific [[sign (medicine)|medical sign]], having many causes, which can broadly be broken down into [[infection]], [[hepatic tumour]]s, and [[metabolic disorder]]. Often, hepatomegaly presents as an [[abdominal mass]]. Depending on the cause, it may sometimes present along with [[jaundice]].<ref name="pat">{{Cite web| url = http://patient.info/doctor/hepatomegaly| title = Hepatomegaly. Read about Hepatomegaly (enlarged liver) {{!}} Patient| website = Patient| language = en-GB| access-date = 2016-02-27| archive-date = 2022-02-01| archive-url = https://web.archive.org/web/20220201171419/https://patient.info/doctor/hepatomegaly| url-status = live}}</ref> |
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⚫ | '''Hepatomegaly''' is |
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==Signs and symptoms== |
==Signs and symptoms== |
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The |
The patient may experience many symptoms, including weight loss, [[poor appetite]], and [[lethargy]]; [[jaundice]] and bruising may also be present.<ref name=pat/> |
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==Causes== |
==Causes== |
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===Infective=== |
===Infective=== |
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{{columns-list|colwidth=22em| |
{{columns-list|colwidth=22em| |
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*[[Glandular fever]] (Infectious mononucleosis)<ref name=pat/> |
* [[Glandular fever]] (Infectious mononucleosis)<ref name=pat/> |
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*[[Hepatitis]] (A, B |
* [[Hepatitis]] (A, B, C)<ref name=nih/> |
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*[[Liver abscess]] (pyogenic abscess)<ref name=pat/> |
* [[Liver abscess]] (pyogenic abscess)<ref name=pat/> |
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*[[Malaria]]<ref name=pat/> |
* [[Malaria]]<ref name=pat/> |
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*[[Amoeba]] infections<ref>{{Cite book|url=https://books.google.com/books?id=DdBJ6jCf8KgC|title=Encyclopedia of Molecular Mechanisms of Disease: With 213 Tables|last=Lang|first=Florian|date=2009-03-19|publisher=Springer Science & Business Media|page=824|isbn=9783540671367|language=en}}</ref> |
* [[Amoeba]] infections<ref>{{Cite book|url=https://books.google.com/books?id=DdBJ6jCf8KgC|title=Encyclopedia of Molecular Mechanisms of Disease: With 213 Tables|last=Lang|first=Florian|date=2009-03-19|publisher=Springer Science & Business Media|page=824|isbn=9783540671367|language=en|access-date=2016-03-11|archive-date=2023-01-12|archive-url=https://web.archive.org/web/20230112194830/https://books.google.com/books?id=DdBJ6jCf8KgC|url-status=live}}</ref> |
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*[[Hydatid cyst]]<ref>{{Cite web|url=https://www.cdc.gov/parasites/echinococcosis/health_professionals/|title=CDC - Echinococcosis - Resources for Health Professionals|last=Prevention|first=CDC - Centers for Disease Control and|website=www.cdc.gov|language=en-us|access-date=2016-03-11}}</ref> |
* [[Hydatid cyst]]<ref>{{Cite web|url=https://www.cdc.gov/parasites/echinococcosis/health_professionals/|title=CDC - Echinococcosis - Resources for Health Professionals|last=Prevention|first=CDC - Centers for Disease Control and|website=www.cdc.gov|language=en-us|access-date=2016-03-11|archive-date=2016-03-11|archive-url=https://web.archive.org/web/20160311194442/http://www.cdc.gov/parasites/echinococcosis/health_professionals/|url-status=live}}</ref> |
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*[[Leptospirosis]]<ref>{{Cite web|url=http://patient.info/doctor/leptospirosis-weils-disease|title=Leptospirosis (Weil's Disease) {{!}} Doctor {{!}} Patient|website=Patient|language=en-GB|access-date=2016-03-11}}</ref> |
* [[Leptospirosis]]<ref>{{Cite web|url=http://patient.info/doctor/leptospirosis-weils-disease|title=Leptospirosis (Weil's Disease) {{!}} Doctor {{!}} Patient|website=Patient|language=en-GB|access-date=2016-03-11|archive-date=2016-03-11|archive-url=https://web.archive.org/web/20160311183751/http://patient.info/doctor/leptospirosis-weils-disease|url-status=live}}</ref> |
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*[[Actinomycosis]]<ref>{{Cite book|url=https://books.google.com/books?id=O3nGBAAAQBAJ|title=Homeostasis - Tumor - Metastasis|last=Banfalvi|first=Gaspar|date=2013-10-16|publisher=Springer Science & Business Media|page=145|isbn=9789400773356|language=en}}</ref> |
* [[Actinomycosis]]<ref>{{Cite book|url=https://books.google.com/books?id=O3nGBAAAQBAJ|title=Homeostasis - Tumor - Metastasis|last=Banfalvi|first=Gaspar|date=2013-10-16|publisher=Springer Science & Business Media|page=145|isbn=9789400773356|language=en}}</ref> |
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===Neoplastic=== |
===Neoplastic=== |
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*Metastatic tumours<ref name=nih/> |
* Metastatic tumours<ref name=nih/> |
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*[[Hepatocellular carcinoma]]<ref name=nih/> |
* [[Hepatocellular carcinoma]]<ref name=nih/> |
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*[[Myeloma]]<ref name=pat/> |
* [[Myeloma]]<ref name=pat/> |
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*[[Leukemia]]<ref name=nih/> |
* [[Leukemia]]<ref name=nih/> |
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*[[Lymphoma]]<ref name=pat/> |
* [[Lymphoma]]<ref name=pat/> |
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===Biliary=== |
===Biliary=== |
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*[[Primary biliary cirrhosis]].<ref name=pat/> |
* [[Primary biliary cirrhosis]].<ref name=pat/> |
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*[[Primary sclerosing cholangitis]].<ref name=pat/> |
* [[Primary sclerosing cholangitis]].<ref name=pat/> |
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===Metabolic=== |
===Metabolic=== |
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*[[Haemochromatosis]]<ref name=pat/> |
* [[Haemochromatosis]]<ref name=pat/> |
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*[[Cholesteryl ester storage disease]]<ref>{{Cite web|url=http://rarediseases.org/rare-diseases/cholesteryl-ester-storage-disease/|title=Cholesteryl Ester Storage Disease - NORD (National Organization for Rare Disorders)|website=NORD (National Organization for Rare Disorders)|language=en-US|access-date=2016-03-11}}</ref> |
* [[Cholesteryl ester storage disease]]<ref>{{Cite web|url=http://rarediseases.org/rare-diseases/cholesteryl-ester-storage-disease/|title=Cholesteryl Ester Storage Disease - NORD (National Organization for Rare Disorders)|website=NORD (National Organization for Rare Disorders)|language=en-US|access-date=2016-03-11|archive-date=2016-03-12|archive-url=https://web.archive.org/web/20160312011603/http://rarediseases.org/rare-diseases/cholesteryl-ester-storage-disease/|url-status=live}}</ref> |
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*[[Porphyria]]<ref name=pat/> |
* [[Porphyria]]<ref name=pat/> |
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*[[Wilson's disease]]<ref name=pat/> |
* [[Wilson's disease]]<ref name=pat/> |
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*[[ |
* [[Niemann–Pick disease]]<ref name=nih/> |
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*[[Non-alcoholic fatty liver disease]].<ref name=pat/> |
* [[Non-alcoholic fatty liver disease]].<ref name=pat/> |
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*[[Glycogen storage disease]] (GSD)<ref name=nih/> |
* [[Glycogen storage disease]] (GSD)<ref name=nih/> |
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* [[Glycogenic hepatopathy]] (Mauriac syndrome)<ref>{{cite journal |last1=Sherigar |first1=JM |last2=Castro |first2=J |last3=Yin |first3=YM |last4=Guss |first4=D |last5=Mohanty |first5=SR |title=Glycogenic hepatopathy: A narrative review. |journal=World Journal of Hepatology |date=27 February 2018 |volume=10 |issue=2 |pages=172–185 |doi=10.4254/wjh.v10.i2.172 |pmid=29527255 |pmc=5838438 |doi-access=free }}</ref> |
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===Drugs (including alcohol)=== |
===Drugs (including alcohol)=== |
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*[[Alcohol (drug)|Alcohol]] |
* [[Alcohol (drug)|Alcohol use disorder]]<ref name=nih/> |
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*Drug-induced hepatitis<ref name=pat/> |
* Drug-induced hepatitis<ref name=pat/> |
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===Congenital=== |
===Congenital=== |
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*[[Hemolytic anemia]]<ref name=pat/> |
* [[Hemolytic anemia]]<ref name=pat/> |
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*[[Polycystic |
* [[Polycystic liver disease]]<ref name=pat/> |
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*[[Sickle cell disease]]<ref name=pat/> |
* [[Sickle cell disease]]<ref name=pat/> |
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*[[Hereditary fructose intolerance]]<ref name=nih/> |
* [[Hereditary fructose intolerance]]<ref name=nih/> |
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===Others=== |
===Others=== |
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*[[Hunter syndrome]] ( |
* [[Hunter syndrome]] (spleen affected)<ref>{{Cite web|url=http://patient.info/doctor/hunters-syndrome|title=Hunter's Syndrome. MPS II information; symptoms {{!}} Patient|website=Patient|date=20 August 2014|language=en-GB|access-date=2016-03-11|archive-date=2016-03-12|archive-url=https://web.archive.org/web/20160312013839/http://patient.info/doctor/hunters-syndrome|url-status=live}}</ref> |
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*[[Zellweger's syndrome]]<ref>{{Cite web|url=http://www.omim.org/entry/214100 |title=OMIM Entry |
* [[Zellweger's syndrome]]<ref>{{Cite web|url=http://www.omim.org/entry/214100 |archive-url=https://web.archive.org/web/20150214125712/http://omim.org/entry/214100 |url-status=dead |archive-date=2015-02-14 |title=OMIM Entry - # 214100 - PEROXISOME BIOGENESIS DISORDER 1A (ZELLWEGER); PBD1A |website=www.omim.org |access-date=2016-03-11 }}</ref> |
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*[[Carnitine palmitoyltransferase I deficiency]]<ref>{{Cite web|url=https://ghr.nlm.nih.gov/condition/carnitine-palmitoyltransferase-i-deficiency|title=CPT I deficiency|date=2016-03-07|website=Genetics Home Reference|access-date=2016-03-11}}</ref> |
* [[Carnitine palmitoyltransferase I deficiency]]<ref>{{Cite web|url=https://ghr.nlm.nih.gov/condition/carnitine-palmitoyltransferase-i-deficiency|title=CPT I deficiency|date=2016-03-07|website=Genetics Home Reference|access-date=2016-03-11|archive-date=2020-09-19|archive-url=https://web.archive.org/web/20200919215044/https://ghr.nlm.nih.gov/condition/carnitine-palmitoyltransferase-i-deficiency|url-status=live}}</ref> |
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*Granulomatous: [[Sarcoidosis]]<ref>{{Cite web|url=http://patient.info/doctor/sarcoidosis-pro|title=Sarcoidosis {{!}} Doctor {{!}} Patient|website=Patient|language=en-GB|access-date=2016-03-11}}</ref> |
* Granulomatous: [[Sarcoidosis]]<ref>{{Cite web|url=http://patient.info/doctor/sarcoidosis-pro|title=Sarcoidosis {{!}} Doctor {{!}} Patient|website=Patient|language=en-GB|access-date=2016-03-11|archive-date=2016-03-11|archive-url=https://web.archive.org/web/20160311205141/http://patient.info/doctor/sarcoidosis-pro|url-status=live}}</ref> |
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}} |
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==Mechanism== |
==Mechanism== |
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The mechanism of hepatomegaly consists of [[vascular]] swelling, [[inflammation]] ( |
The mechanism of hepatomegaly consists of [[vascular]] swelling, [[inflammation]] ([[infectious]] in origin), and deposition of (1) non-hepatic cells or (2) increased cell contents (such as that due to iron in [[hemochromatosis]] or [[hemosiderosis]] and fat in fatty liver disease).<ref>{{Cite book|url=https://books.google.com/books?id=FIV-NYPRCzEC&q=Hepatomegaly%2520mechanism&pg=PA469|title=Mechanisms of Clinical Signs|last1=Dennis|first1=Mark|last2=Bowen|first2=William Talbot|last3=Cho|first3=Lucy|date=2012-01-01|publisher=Elsevier Australia|page=469|isbn=9780729540759|language=en|access-date=2020-10-25|archive-date=2023-01-12|archive-url=https://web.archive.org/web/20230112194904/https://books.google.com/books?id=FIV-NYPRCzEC&q=Hepatomegaly%2520mechanism&pg=PA469|url-status=live}}</ref> |
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==Diagnosis== |
==Diagnosis== |
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[[File:Liver measurements on ultrasonography.jpg|thumb|[[Abdominal ultrasonography]] of the liver, as a [[sagittal plane]] through the [[midclavicular line]], with some standard measurements |
[[File:Liver measurements on ultrasonography.jpg|thumb|[[Abdominal ultrasonography]] of the liver, as a [[sagittal plane]] through the [[midclavicular line]], with some standard measurements<ref name=efsumb2010>{{cite web|url=http://www.kosmos-design.co.uk/efsumb-ecb/ecbse-ch02-ultrasoundliver.pdf|title=Ultrasound of the liver - EFSUMB – European Course Book|website=European federation of societies for ultrasound in medicine and biology (EFSUMB)|author=Christoph F. Dietrich, Carla Serra, Maciej Jedrzejczyk|date=2010-07-28|access-date=2017-12-21|archive-url=https://web.archive.org/web/20170812135306/http://www.kosmos-design.co.uk/efsumb-ecb/ecbse-ch02-ultrasoundliver.pdf|archive-date=2017-08-12|url-status=dead}}</ref>]] |
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[[File:Liver size at the midclavicular line at 0 to 7 years.png|thumb|140 px|Right lobe of the liver at the [[midclavicular line]] at ages 0 to 7 |
[[File:Liver size at the midclavicular line at 0 to 7 years.png|thumb|140 px|Right lobe of the liver at the [[midclavicular line]] at ages 0 to 7<ref name="RochaFerrer2009">{{cite journal|last1=Rocha|first1=Silvia Maria Sucena da|last2=Ferrer|first2=Ana Paula Scoleze|last3=Oliveira|first3=Ilka Regina Souza de|last4=Widman|first4=Azzo|last5=Chammas|first5=Maria Cristina|last6=Oliveira|first6=Luiz Antonio Nunes de|last7=Cerri|first7=Giovanni Guido|title=Determinação do tamanho do fígado de crianças normais, entre 0 e 7 anos, por ultrassonografia|journal=Radiologia Brasileira|volume=42|issue=1|year=2009|pages=7–13|issn=0100-3984|doi=10.1590/S0100-39842009000100004|doi-access=free}}</ref>]] |
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Suspicion of hepatomegaly indicates a thorough [[medical history]] and [[Abdominal examination|physical examination]], wherein the latter typically includes an increased [[liver span]]. {{citation needed|date=January 2018}} |
Suspicion of hepatomegaly indicates a thorough [[medical history]] and [[Abdominal examination|physical examination]], wherein the latter typically includes an increased [[liver span]]. {{citation needed|date=January 2018}} |
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On [[abdominal ultrasonography]], the liver can be measured by the ''maximum dimension'' on a [[sagittal plane]] view through the [[midclavicular line]], which is normally up to 18 cm in adults.<ref name=efsumb2010/> It is also possible to measure the ''[[Anatomical terms of location#Axes|cranio-caudal]] dimension'', which is normally up to 15 cm in adults.<ref name=efsumb2010/> This can be measured together with the ''[[Anatomical terms of location#Axes|ventro-dorsal]] dimension'' (or ''depth''), which is normally up to 13 cm.<ref name=efsumb2010/> Also, the [[caudate lobe]] is enlarged in many diseases. In the [[axial plane]], the caudate lobe should normally have a cross-section of less than 0.55 of the rest of the liver.<ref name=efsumb2010/> |
On [[abdominal ultrasonography]], the liver can be measured by the ''maximum dimension'' on a [[sagittal plane]] view through the [[midclavicular line]], which is normally up to 18 cm in adults.<ref name=efsumb2010/> It is also possible to measure the ''[[Anatomical terms of location#Axes|cranio-caudal]] dimension'', which is normally up to 15 cm in adults.<ref name=efsumb2010/> This can be measured together with the ''[[Anatomical terms of location#Axes|ventro-dorsal]] dimension'' (or ''depth''), which is normally up to 13 cm.<ref name=efsumb2010/> Also, the [[caudate lobe]] is enlarged in many diseases. In the [[axial plane]], the caudate lobe should normally have a cross-section of less than 0.55 of the rest of the liver.<ref name=efsumb2010/> |
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Other [[ultrasound]] studies have suggested hepatomegaly as being defined as a longitudinal axis > |
Other [[ultrasound]] studies have suggested hepatomegaly as being defined as a longitudinal axis > 15.5 cm at the hepatic midline, or > 16.0 cm at the [[midclavicular line]].<ref>{{cite journal |last1=Gosink |first1=BB |last2=Leymaster |first2=CE |title=Ultrasonic determination of hepatomegaly. |journal=Journal of Clinical Ultrasound |date=January 1981 |volume=9 |issue=1 |pages=37–44 |pmid=6792230|doi=10.1002/jcu.1870090110 |s2cid=22827636 }}</ref><ref>{{cite journal |last1=Kratzer |first1=W |last2=Fritz |first2=V |last3=Mason |first3=RA |last4=Haenle |first4=MM |last5=Kaechele |first5=V |last6=Roemerstein Study |first6=Group. |title=Factors affecting liver size: a sonographic survey of 2080 subjects. |journal=Journal of Ultrasound in Medicine |date=November 2003 |volume=22 |issue=11 |pages=1155–61 |doi=10.7863/jum.2003.22.11.1155 |pmid=14620885|s2cid=29904060 |doi-access=free }}</ref> |
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===Workup=== |
===Workup=== |
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[[Blood test]]s should be done, |
[[Blood test]]s should be done, especially [[liver function test|liver-function tests]], which give a good impression of the patient's broad metabolic picture.{{medical citation needed|date=February 2016}} |
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A complete blood test can help distinguish intrinsic liver disease from extrahepatic [[jaundice|bile-duct obstruction]].<ref>{{Cite book|url=https://books.google.com/books?id=40Z9CAAAQBAJ|title=Goldman-Cecil Medicine| |
A complete blood test can help distinguish intrinsic liver disease from extrahepatic [[jaundice|bile-duct obstruction]].<ref>{{Cite book|url=https://books.google.com/books?id=40Z9CAAAQBAJ|title=Goldman-Cecil Medicine|last1=Goldman|first1=Lee|last2=Schafer|first2=Andrew I.|date=2015-04-21|publisher=Elsevier Health Sciences|page=991|isbn=9780323322850|language=en}}</ref> An [[ultrasound]] of the liver can reliably detect a dilated [[bile duct|biliary-duct]] system,<ref>{{Cite journal|last1=Meacock|first1=L M|last2=Sellars|first2=M E|last3=Sidhu|first3=P S|date=2010-07-01|title=Evaluation of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound|journal=The British Journal of Radiology|volume=83|issue=991|pages=615–627|doi=10.1259/bjr/60619911|issn=0007-1285|pmc=3473688|pmid=20603412}}</ref> |
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it can also detect the characteristics of a [[liver cirrhosis|cirrhotic liver]].<ref>{{Cite book|url=https://books.google.com/books?id=HzC5BAAAQBAJ|title=Diseases of the Liver in Children: Evaluation and Management| |
it can also detect the characteristics of a [[liver cirrhosis|cirrhotic liver]].<ref>{{Cite book|url=https://books.google.com/books?id=HzC5BAAAQBAJ|title=Diseases of the Liver in Children: Evaluation and Management|last1=Murray|first1=Karen F.|last2=Horslen|first2=Simon|date=2013-12-11|publisher=Springer Science & Business Media|page=199|isbn=9781461490050|language=en}}</ref> |
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[[Computerized tomography]] (CT) can |
[[Computerized tomography]] (CT) can give accurate [[anatomy|anatomical]] information for a complete diagnosis.<ref>{{Cite book|url=https://books.google.com/books?id=E3tYBAAAQBAJ|title=Problem Solving in Emergency Radiology|last1=Mirvis|first1=Stuart E.|last2=Soto|first2=Jorge A.|last3=Shanmuganathan|first3=Kathirkamanathan|last4=Yu|first4=Joseph|last5=Kubal|first5=Wayne S.|date=2014-08-19|publisher=Elsevier Health Sciences|page=442|isbn=9781455758395|language=en}}</ref> |
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==Treatment== |
==Treatment== |
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[[File:Prednisone2.png|140 px|thumb|left| |
[[File:Prednisone2.png|140 px|thumb|left| |
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Prednisone]] |
Prednisone]] |
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Treatment of hepatomegaly |
Treatment of hepatomegaly varies with the cause, so accurate diagnosis is the first concern. In auto-immune liver disease, [[prednisone]] and [[azathioprine]] may be used for treatment.<ref name="cir">{{cite web |title=Cirrhosis: Practice Essentials, Overview, Etiology |url=https://emedicine.medscape.com/article/185856-overview#a12 |website=Medscape |access-date=16 May 2024 |date=22 July 2021}}</ref> |
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In |
In lymphoma the treatment options include single-agent (or multi-agent) [[chemotherapy]] and regional radiotherapy, and surgery is an option in specific situations. Meningococcal group C conjugate [[vaccine]] is used in some cases.<ref>{{Cite web|url=http://patient.info/doctor/non-hodgkins-lymphoma-pro|title=Non-Hodgkin's Lymphoma {{!}} Doctor {{!}} Patient|website=Patient|language=en-GB|access-date=2016-03-11|archive-date=2018-02-08|archive-url=https://web.archive.org/web/20180208123453/https://patient.info/doctor/non-hodgkins-lymphoma-pro|url-status=live}}</ref> |
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In primary biliary cirrhosis [[ursodeoxycholic acid]] helps the bloodstream remove bile which may increase survival |
In primary biliary cirrhosis, [[ursodeoxycholic acid]] helps the bloodstream remove bile, which may increase survival.<ref>{{Cite web|url=https://www.nlm.nih.gov/medlineplus/ency/article/000282.htm|title=Primary biliary cirrhosis: MedlinePlus Medical Encyclopedia|website=www.nlm.nih.gov|access-date=2016-03-12|archive-date=2016-07-05|archive-url=https://web.archive.org/web/20160705053938/https://www.nlm.nih.gov/medlineplus/ency/article/000282.htm|url-status=live}}</ref> |
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{{clear}} |
{{clear}} |
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==See also== |
==See also== |
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*[[Hepatosplenomegaly]] |
* [[Hepatosplenomegaly]] |
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*[[Liver function tests]] |
* [[Liver function tests]] |
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==References== |
==References== |
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==Further reading== |
==Further reading== |
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*{{Cite book|url=https://books.google.com/?id=ILIs-P6sDekC |
* {{Cite book|url=https://books.google.com/books?id=ILIs-P6sDekC&q=hepatomegaly&pg=PA105|title=Inherited Metabolic Diseases: A Clinical Approach|last1=Hoffmann|first1=Georg F.|last2=Zschocke|first2=Johannes|last3=Nyhan|first3=William L.|date=2009-11-21|publisher=Springer Science & Business Media|isbn=9783540747239|language=en}} |
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*{{Cite journal| |
* {{Cite journal|last1=Kim|first1=Sun Bean|last2=Kim|first2=Do Kyung|last3=Byun|first3=Sun Jeong|last4=Park|first4=Ji Hye|last5=Choi|first5=Jin Young|last6=Park|first6=Young Nyun|last7=Kim|first7=Do Young|date=2015-12-01|title=Peliosis hepatis presenting with massive hepatomegaly in a patient with idiopathic thrombocytopenic purpura|journal=Clinical and Molecular Hepatology|volume=21|issue=4|pages=387–392|doi=10.3350/cmh.2015.21.4.387|issn=2287-2728|pmc=4712167|pmid=26770928}} |
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== External links == |
== External links == |
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⚫ | |||
{{Medical resources |
{{Medical resources |
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| ICD10 = {{ICD10|R|16|.0|r|16}} |
| ICD10 = {{ICD10|R|16|.0|r|16}} |
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| ICD9 = {{ICD9|789.1}} |
| ICD9 = {{ICD9|789.1}} |
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| MedlinePlus = 003275 |
| MedlinePlus = 003275 |
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}} |
}} |
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{{Scholia|topic}} |
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⚫ | |||
{{Digestive system and abdomen symptoms and signs}} |
{{Digestive system and abdomen symptoms and signs}} |
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{{Medicine}} |
{{Medicine}} |
Latest revision as of 18:07, 19 July 2024
Hepatomegaly | |
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Computerized tomography of affected person with hepatomegaly | |
Specialty | Hepatology |
Symptoms | Weight loss, lethargy[1] |
Causes | Liver abscess (pyogenic abscess), Malaria[1] |
Diagnostic method | Abdominal ultrasonography[2] |
Treatment | Prednisone and azathioprine[3] |
Hepatomegaly is enlargement of the liver.[4] It is a non-specific medical sign, having many causes, which can broadly be broken down into infection, hepatic tumours, and metabolic disorder. Often, hepatomegaly presents as an abdominal mass. Depending on the cause, it may sometimes present along with jaundice.[1]
Signs and symptoms
[edit]The patient may experience many symptoms, including weight loss, poor appetite, and lethargy; jaundice and bruising may also be present.[1]
Causes
[edit]Among the causes of hepatomegaly are the following:
Infective
[edit]- Glandular fever (Infectious mononucleosis)[1]
- Hepatitis (A, B, C)[4]
- Liver abscess (pyogenic abscess)[1]
- Malaria[1]
- Amoeba infections[5]
- Hydatid cyst[6]
- Leptospirosis[7]
- Actinomycosis[8]
Neoplastic
Biliary
Metabolic
- Haemochromatosis[1]
- Cholesteryl ester storage disease[9]
- Porphyria[1]
- Wilson's disease[1]
- Niemann–Pick disease[4]
- Non-alcoholic fatty liver disease.[1]
- Glycogen storage disease (GSD)[4]
- Glycogenic hepatopathy (Mauriac syndrome)[10]
Drugs (including alcohol)
- Alcohol use disorder[4]
- Drug-induced hepatitis[1]
Congenital
- Hemolytic anemia[1]
- Polycystic liver disease[1]
- Sickle cell disease[1]
- Hereditary fructose intolerance[4]
Others
- Hunter syndrome (spleen affected)[11]
- Zellweger's syndrome[12]
- Carnitine palmitoyltransferase I deficiency[13]
- Granulomatous: Sarcoidosis[14]
Mechanism
[edit]The mechanism of hepatomegaly consists of vascular swelling, inflammation (infectious in origin), and deposition of (1) non-hepatic cells or (2) increased cell contents (such as that due to iron in hemochromatosis or hemosiderosis and fat in fatty liver disease).[15]
Diagnosis
[edit]Suspicion of hepatomegaly indicates a thorough medical history and physical examination, wherein the latter typically includes an increased liver span. [citation needed]
On abdominal ultrasonography, the liver can be measured by the maximum dimension on a sagittal plane view through the midclavicular line, which is normally up to 18 cm in adults.[2] It is also possible to measure the cranio-caudal dimension, which is normally up to 15 cm in adults.[2] This can be measured together with the ventro-dorsal dimension (or depth), which is normally up to 13 cm.[2] Also, the caudate lobe is enlarged in many diseases. In the axial plane, the caudate lobe should normally have a cross-section of less than 0.55 of the rest of the liver.[2]
Other ultrasound studies have suggested hepatomegaly as being defined as a longitudinal axis > 15.5 cm at the hepatic midline, or > 16.0 cm at the midclavicular line.[17][18]
Workup
[edit]Blood tests should be done, especially liver-function tests, which give a good impression of the patient's broad metabolic picture.[medical citation needed]
A complete blood test can help distinguish intrinsic liver disease from extrahepatic bile-duct obstruction.[19] An ultrasound of the liver can reliably detect a dilated biliary-duct system,[20] it can also detect the characteristics of a cirrhotic liver.[21]
Computerized tomography (CT) can give accurate anatomical information for a complete diagnosis.[22]
Treatment
[edit]Treatment of hepatomegaly varies with the cause, so accurate diagnosis is the first concern. In auto-immune liver disease, prednisone and azathioprine may be used for treatment.[3]
In lymphoma the treatment options include single-agent (or multi-agent) chemotherapy and regional radiotherapy, and surgery is an option in specific situations. Meningococcal group C conjugate vaccine is used in some cases.[23]
In primary biliary cirrhosis, ursodeoxycholic acid helps the bloodstream remove bile, which may increase survival.[24]
See also
[edit]References
[edit]- ^ a b c d e f g h i j k l m n o p q r s "Hepatomegaly. Read about Hepatomegaly (enlarged liver) | Patient". Patient. Archived from the original on 2022-02-01. Retrieved 2016-02-27.
- ^ a b c d e f Christoph F. Dietrich, Carla Serra, Maciej Jedrzejczyk (2010-07-28). "Ultrasound of the liver - EFSUMB – European Course Book" (PDF). European federation of societies for ultrasound in medicine and biology (EFSUMB). Archived from the original (PDF) on 2017-08-12. Retrieved 2017-12-21.
{{cite web}}
: CS1 maint: multiple names: authors list (link) - ^ a b "Cirrhosis: Practice Essentials, Overview, Etiology". Medscape. 22 July 2021. Retrieved 16 May 2024.
- ^ a b c d e f g h i "Hepatomegaly: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Archived from the original on 2016-07-05. Retrieved 2016-02-27.
- ^ Lang, Florian (2009-03-19). Encyclopedia of Molecular Mechanisms of Disease: With 213 Tables. Springer Science & Business Media. p. 824. ISBN 9783540671367. Archived from the original on 2023-01-12. Retrieved 2016-03-11.
- ^ Prevention, CDC - Centers for Disease Control and. "CDC - Echinococcosis - Resources for Health Professionals". www.cdc.gov. Archived from the original on 2016-03-11. Retrieved 2016-03-11.
- ^ "Leptospirosis (Weil's Disease) | Doctor | Patient". Patient. Archived from the original on 2016-03-11. Retrieved 2016-03-11.
- ^ Banfalvi, Gaspar (2013-10-16). Homeostasis - Tumor - Metastasis. Springer Science & Business Media. p. 145. ISBN 9789400773356.
- ^ "Cholesteryl Ester Storage Disease - NORD (National Organization for Rare Disorders)". NORD (National Organization for Rare Disorders). Archived from the original on 2016-03-12. Retrieved 2016-03-11.
- ^ Sherigar, JM; Castro, J; Yin, YM; Guss, D; Mohanty, SR (27 February 2018). "Glycogenic hepatopathy: A narrative review". World Journal of Hepatology. 10 (2): 172–185. doi:10.4254/wjh.v10.i2.172. PMC 5838438. PMID 29527255.
- ^ "Hunter's Syndrome. MPS II information; symptoms | Patient". Patient. 20 August 2014. Archived from the original on 2016-03-12. Retrieved 2016-03-11.
- ^ "OMIM Entry - # 214100 - PEROXISOME BIOGENESIS DISORDER 1A (ZELLWEGER); PBD1A". www.omim.org. Archived from the original on 2015-02-14. Retrieved 2016-03-11.
- ^ "CPT I deficiency". Genetics Home Reference. 2016-03-07. Archived from the original on 2020-09-19. Retrieved 2016-03-11.
- ^ "Sarcoidosis | Doctor | Patient". Patient. Archived from the original on 2016-03-11. Retrieved 2016-03-11.
- ^ Dennis, Mark; Bowen, William Talbot; Cho, Lucy (2012-01-01). Mechanisms of Clinical Signs. Elsevier Australia. p. 469. ISBN 9780729540759. Archived from the original on 2023-01-12. Retrieved 2020-10-25.
- ^ Rocha, Silvia Maria Sucena da; Ferrer, Ana Paula Scoleze; Oliveira, Ilka Regina Souza de; Widman, Azzo; Chammas, Maria Cristina; Oliveira, Luiz Antonio Nunes de; Cerri, Giovanni Guido (2009). "Determinação do tamanho do fígado de crianças normais, entre 0 e 7 anos, por ultrassonografia". Radiologia Brasileira. 42 (1): 7–13. doi:10.1590/S0100-39842009000100004. ISSN 0100-3984.
- ^ Gosink, BB; Leymaster, CE (January 1981). "Ultrasonic determination of hepatomegaly". Journal of Clinical Ultrasound. 9 (1): 37–44. doi:10.1002/jcu.1870090110. PMID 6792230. S2CID 22827636.
- ^ Kratzer, W; Fritz, V; Mason, RA; Haenle, MM; Kaechele, V; Roemerstein Study, Group. (November 2003). "Factors affecting liver size: a sonographic survey of 2080 subjects". Journal of Ultrasound in Medicine. 22 (11): 1155–61. doi:10.7863/jum.2003.22.11.1155. PMID 14620885. S2CID 29904060.
- ^ Goldman, Lee; Schafer, Andrew I. (2015-04-21). Goldman-Cecil Medicine. Elsevier Health Sciences. p. 991. ISBN 9780323322850.
- ^ Meacock, L M; Sellars, M E; Sidhu, P S (2010-07-01). "Evaluation of gallbladder and biliary duct disease using microbubble contrast-enhanced ultrasound". The British Journal of Radiology. 83 (991): 615–627. doi:10.1259/bjr/60619911. ISSN 0007-1285. PMC 3473688. PMID 20603412.
- ^ Murray, Karen F.; Horslen, Simon (2013-12-11). Diseases of the Liver in Children: Evaluation and Management. Springer Science & Business Media. p. 199. ISBN 9781461490050.
- ^ Mirvis, Stuart E.; Soto, Jorge A.; Shanmuganathan, Kathirkamanathan; Yu, Joseph; Kubal, Wayne S. (2014-08-19). Problem Solving in Emergency Radiology. Elsevier Health Sciences. p. 442. ISBN 9781455758395.
- ^ "Non-Hodgkin's Lymphoma | Doctor | Patient". Patient. Archived from the original on 2018-02-08. Retrieved 2016-03-11.
- ^ "Primary biliary cirrhosis: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Archived from the original on 2016-07-05. Retrieved 2016-03-12.
Further reading
[edit]- Hoffmann, Georg F.; Zschocke, Johannes; Nyhan, William L. (2009-11-21). Inherited Metabolic Diseases: A Clinical Approach. Springer Science & Business Media. ISBN 9783540747239.
- Kim, Sun Bean; Kim, Do Kyung; Byun, Sun Jeong; Park, Ji Hye; Choi, Jin Young; Park, Young Nyun; Kim, Do Young (2015-12-01). "Peliosis hepatis presenting with massive hepatomegaly in a patient with idiopathic thrombocytopenic purpura". Clinical and Molecular Hepatology. 21 (4): 387–392. doi:10.3350/cmh.2015.21.4.387. ISSN 2287-2728. PMC 4712167. PMID 26770928.